SELF ADMINISTRATION OF INSULIN

Does self administration of insulin yield clinically better blood sugar levels as compared to use of the insulin pump?

Table of Contents

Introduction3

Combining Diabetes Technologies: A Standard of Care in the Making5

Integrating CSII and CGM6

Establishing an Education Protocol9

Methodology for Looking at Reports12

Sensor Daily Overlay13

Sensor Overlay by Meal13

Daily Summary14

Quick View Summary14

Device Settings Report14

Health Impact15

Literature Review17

Does self administration of insulin yield clinically better blood sugar levels as compared to use of the insulin pump?18

Research Design21

Selection Criteria21

Data Collection21

Outcome Measures22

Data Analysis22

Results22

Conclusions25

Implications28

Does self administration of insulin yield clinically better blood sugar levels as compared to use of the insulin pump?

Introduction

For people with diabetes who use intensive insulin therapy for management, achieving near-normal or normal blood glucose levels requires obtaining, retaining, processing, and applying vast amounts of information in the course of everyday life. Evolving technologies have provided new opportunities for diabetes educators to help insulin-requiring patients, particularly those with type 1 diabetes, gain and use information more effectively. CSII systems (insulin pumps), introduced in the late 1970s, offer multiple basal rates and incorporate software that calculates appropriate boluses, taking into account the patient's current blood glucose level, insulin sensitivity, and insulin to carbohydrate ratios, the amount of carbohydrate to be consumed, and the amount of currently active insulin. More recently, continuous glucose monitoring (CGM) devices were developed to augment traditional self administration/monitoring of blood glucose (SMBG) by providing more frequent data and by indicating the direction, magnitude, duration, frequency, and, when used with logbook records, causes of glucose fluctuations. Both technologies are compatible with therapy management software programs designed to give patients more convenient access to blood glucose data and, by extension, greater insight into their metabolic control.

In 2008, the functionalities of CSII and CGM were combined into 1 product, the MiniMed Paradigm REAL Time System (Medtronic, Inc., Northridge, CA). This sensor-augmented insulin pump wirelessly transmits information every 5 minutes from a subcutaneous sensor to a CSII device, where the glucose values and trends are displayed for the user. The system is also equipped with alarms to alert patients of glucose levels approaching preprogrammed high or low thresholds. One of the most important advantages of sensor-augmented pump therapy (SAPT) is the collection and storage of all the glucose and insulin delivery information, which can be uploaded to a computer, organized into reports, and reviewed with patients. These reports constitute a readily accessible and individualized visual aid for discerning blood glucose patterns, understanding the cause-and-effect relationships behind these patterns, and determining realistic solutions. However, transitioning patients from injection-based regimens to SAPT can be labor intensive for both clinicians and patients, and, until recently, there were no randomized controlled studies demonstrating outcomes of SAPT versus self administration of blood glucose level. Thus, the question arises as to what the benefits of insulin pumps are compared with self administration therapy, and whether there are additional advantages to moving to an integrated CSII/CGM system.

The study concluded that, in a basal state, patients using an insulin pump have greater glycemic control than patients using ...